In The Press

Torn

From Caring Magazine, Fall 2007

The CMH
Emergency
Department and
Heart Team
respond to a torn
aorta and a 90%
mortality rate.

More than two months after the fateful mid-August Sunday, Christine Grandpre still
tears up at the memory. She knows how close she came to losing her 44-year-old husband,
Christopher. And Christopher knows that without a speedy, accurate and difficult diagnosis of
an aortic dissection – a tear in the inner layers of the aorta, the same medical emergency actor
John Ritter died from – in the ED, followed by a six-hour operation by cardiovascular surgeon
Dr. Lamar Bushnell and Community Memorial Hospital’s expert “Heart Team,” his wife would
today be a widow raising their two young daughters by herself.

“I thought I wasn’t going to make it. The odds were not with me,” says Christopher, who
grew up in Westlake and has lived in Oxnard for the past eight years. “I’m not overly religious,
but thank God for CMH and its outstanding doctors.”

Dr. Alex Kowblansky, CMH’s Emergency Department Medical Director, was the first
physician to see Christopher when he came through the ED doors. Though the life threatening
dissection usually happens quite suddenly – in Christopher’s case – he had experienced
symptoms for days which may have been due to very high blood pressure – a common finding
in patients suffering aortic dissection. “With the extent of his dissection the mortality rate is
probably close to 90 percent,” Dr. Kowblansky estimates.

“Off and on that month I had been tired,
but didn’t think anything of it,” Christopher
recalls. “The day before I was supposed to go
surfing, but I didn’t because I had no energy,
which is unusual for me.”

Also unusual was the day he had at work
on Friday. A land surveyor, Christopher found
himself struggling to concentrate. “I was straining
to do math. Easy things for me were suddenly
giving me a hard time,” he shares.

Sunday morning, despite still feeling
lethargic, Christopher was on his hands and
knees cleaning the hardwood floors for his wife
when he felt a shooting pain in his neck. “It was
intense,” he says. “My shoulders also hurt and I
had some tightness in my chest.”

Pausing to gather his emotions even in the
retelling, he adds: “Thank God I wasn’t in the
water surfing.”

Christopher sat on the couch to rest,
thinking the pain would pass. Christine, who
had been upstairs with the couples two young
daughters – Chase, 4, and Chelsea, 2 – thought
differently. Because St. John’s Regional Medical
Center was closed for fumigation for a mold
problem, she drove Christopher to Community
Memorial Hospital.

“On the way to the ED the pain got worse,”
Christopher says, including down in his right
leg. “My wife was already scared, but I scared
her even more when I said, ‘You need to hurry
and start running red lights.’”

“It was not the typical profile of a serious
heart problem,” Dr. Kowblansky remembers.
“He’s a very buff, fit guy in his early 40s with no
risk factors.”

An IV quickly brought Christopher’s
plummeting blood pressure back up. His EKG
was normal as was a chest X-ray. However, the
pulse in his right leg was weak. “That raised
a red flag,” Dr. Kowblansky explains. “Now it
sounds like possible aortic dissection.”
The gold standard for diagnosing aortic
dissection – to confirm there is a tear in the
aorta, and not a heart attack – has historically
been an angiogram of the aorta but the
diagnosis can now often be made much more
rapidly with a CT Scan with contrast (dye).
One problem: Christopher’s blood work came
back and indicated his kidney function was not
normal, and the contrast can pose a slight risk
of renal failure.

After discussing the situation with Christopher
and Christine, it was decided to have the
“study of choice” with CMH’s state-of-the-art
CT Scan. It was a wise choice. “It showed a
massive dissection,” Dr. Kowblansky notes.
Christopher’s six siblings quickly arrived;
his parents rushed up from San Diego; and more than a dozen friends from work also showed up
to lend support in the waiting room.

Meanwhile, a call had already been made
to Dr. Bushnell who rushed from the OR
to the ED. “Alex’s diagnosis was right-on,” says
Dr. Bushnell. “This was a surgical emergency.”
As Dr. Bushnell explained to Christopher,
without surgical repair of the torn aortic
wall the mortality rate is twenty-five percent
in the first 24 hours. Fifty percent die in the
first week.

“Most people panic in such a situation but
he was incredibly calm,” Dr. Bushnell remembers.
“He was like, ‘Let’s do it. Let’s go.’”
“It was an easy decision for me,” Christopher
says.

There is nothing easy about the open-heart
operation that includes cooling the patient
to 18 degrees centigrade and turning off the
heart-lung machine during the actual repair
of the aortic arch. A quick-setting, high-tech
bio-glue made of protein is used to put the split
layers of the vessel together. Next, thin sterile sheets of Teflon felt are sewn on the inside
and outside to reinforce the aorta. Oftentimes
the heart valve needs to be replaced, but Dr.
Bushnell was able to save Christopher’s.
Christopher doesn’t remember waking up
later that evening or being visited by Christine
the following day. However, Dr. Kowblansky
remembers seeing Christine that next morning.
And also this: “I remember the last thing I said
to Christopher as he rolled out to go to surgery.
I shook his hand and said, ‘I’ll see you tomorrow
in the ICU.’”

Monday morning, on his way to hopefully
keeping his word, Dr. Kowblansky saw Christine
in the hallway.

“How did he do?” the anxious ED doctor
asked. Christine was speechless.
“She just gave me the biggest bear hug in
the world,” Dr. Kowblansky continues. “I got
teary eyed.”

He pauses, thinks about the “extremely nice
young man” facing the long odds, and adds:
“It was a good save. I still get teary eyed thinking
about it. A lot of things we do in the ED
is small stuff really. Then something like this
comes along. It reminds you what emergency
medicine is all about. This is what we do. We’re
trained for this – to make the right call and see
that definitive care is received.”

Mission accomplished. Christopher left
Community Memorial Hospital after 10 days;
within weeks was walking 30 minutes at a time;
and only nine weeks later was given the medical
clearance to go surfing.

“To be able to tell him he can paddle out
again is a wonderful feeling,” says Dr. Bushnell,
an avid surfer himself.

However, even better was when Dr. Bushnell
told Christopher he could once again lift
his young daughters high overhead, something
they enjoyed and missed.

“For more than two months I couldn’t pick
them up on my shoulders,” Christopher shares,
noting that his daughters call the 12-inch scar
on his sternum “Daddy’s boo-boo.”

“When Dr. Bushnell gave me the OK, I
lifted Chase up, and she was so excited and
happy. She said, ‘You can lift me again, Daddy!’
That was wonderful.”

Daddy knows the story almost didn’t have
a happy ending. “At one point a priest was
brought in,” Christopher shares. “Like I said,
I’m not overly religious, but I am so thankful.
When I was in the ED, I honestly didn’t think
I was going to make it. But I did because I had
absolutely great docs. Thanks to them and the
outstanding nurses and everyone else, I get a
second chance with my girls.”